Critical services could soon impact seniors in Contra Costa County should federal, state and local cuts occur, but that is not stopping Choice in Aging from continuing its mission of keeping people out of skilled nursing facilities.
Back on March 27, the US Department of Health and Human Services (HHS) announced a restructuring in accordance with President Donal Trump’s executive order “Implementing the President’s ‘Department of Government Efficiency’ Workforce Optimization Initiative.” The restructuring plan includes the reorganization of the Administration for Community Living (ACL). The ACL was originally designed to allow older adults and people with disabilities to live where they choose and with the ability to participate fully in their communities, while still getting the care that they need.
According to Debbie Toth, the President and CEO of Choice In Aging, a nonprofit organization that provides services to promote independence of people with disabilities and special needs, the dismantling of ACL will result in devastating changes.
“The elimination of ACL means we lose priority, expertise, uniformity, grants and so much more,” Toth said. “It’s also a clear statement that elders and people with disabilities living in community isn’t a priority. Which is devastating and infuriating!”
There have also been recent threats to Medicaid cuts that pose an additional threat to home and community based services (HCBS), such as Choice in Aging.
“If you look at historic cuts to Medicaid, the first thing to go, always, are home and community based services (HCBS) that keep people out of institutions – and that is us,” Toth said. “Our Adult Day Health Care programs, our Multipurpose Senior Services Programs, and our California Community Transitions would all be decimated by massive cuts to Medicaid as they will be the first on the chopping block if past performance is any indicator of future behavior.”
Toth said that the Choice in Aging Pleasant Hill, CA location is the 16th licensed adult day health care facility in the state and initially began in the late 70s as a response to news coverage that showed terrible things happening to people in skilled nursing facilities. Because of this, the state legislature was in search of a plan to provide people with the care they require from physical therapists, nurses, occupational therapists, and other services, while also allowing them to return to their homes at the end of the day.
According to California Code of Regulations Title 22 regulations, everybody who attends adult day healthcare is at imminent risk of skilled nursing placement and within the next six months, without support and services, they could be placed in a skilled nursing facility.
“Our whole goal is to prevent premature institutionalization, or any at all,” Toth said.
The facility has a general program, a Russian program, a Farsi program, and a mid to late-stage Alzheimer’s program. Each program has its own coordinators, staff, calendars, and the multicultural programs are led in those languages.
Toth said the people they serve are on Medi Cal, veterans, have developmental disabilities or traumatic brain injuries (TBIs), and they are of all different ages. They receive care as necessary throughout the day from the on-site nurses “behind the scenes,” while being able to participate in the activities planned for that day.
“It’s a variety of different reasons that people come but most of them have multiple chronic conditions that need daily management,” Toth said. “All of the activities are therapeutic in some way, whether it’s memory stimulation, occupational therapy, exercise, horticultural therapy. Our purpose is to keep people independent as much as they can be.”
The Pleasant Hill location also holds the Intergenerational Montessori Preschool where the students participate in intergenerational activities, known as Choice in Learning, with the members of the adult day healthcare.
Since Toth joined the organization in 2002, they’ve implemented the Multipurpose Senior Services Program (MSSP) to provide a complex case management team to serve people who are at a skilled nursing level of care, which is now implemented in Contra Costa County, Napa County, and Solano County. The state has also relied on the organization for assistance with California Community Transitions (CCT) and Prevention and Early Access (PEAS). Toth said they also started their own transportation program for the people they serve.
Currently, Toth and the organization are working towards building a new campus, known as the Aging in Place Campus, to hold housing for the people that they serve.
“Our mission is to keep people with disabilities living with dignity and independence, and how can we guarantee that they’re going to have independence if we can’t guarantee that they have a roof over their heads,” Toth said.
After working with the city council, architectural review, and design committee, they received a general plan amendment, in partnership with Satellite Affordable Housing Associates (SAHA), that approved four stories of low income serious housing and 82 units with at least 20 of them being dedicated to veterans.
In addition to the new campus, they will be building a new preschool to allow for the leveling and expansion of their current building, which will provide the capacity to quadruple their adult day healthcare and the ability to build all of their other programs as well.
Toth said that they are currently halfway through their fundraising campaign, where they have raised $16 million from the state, the county, the city, and individual donors, and are in need of another $16 million to reach their goal. In 2024, 51 individuals and organizations have contributed toward building our Aging in Place Campus.
In fact, their recent crab feed fundraiser raised nearly $240k.
Once the Aging in Place campus is up and running, Toth said that they plan to study the campus outcomes, publish their findings as evidence-based, replicate their model, and change the policy and budget drivers that fund institutions rather than community-based options for aging.
“The whole point of the Aging in Place campus is to create a model that will be replicable that allows older adults and adults with disabilities to age in the community, in their setting of choice,” Toth said. “Not in a skilled nursing facility, and have the social, spiritual and health services that they need, all at their front door.”
Currently, Choice in Aging has partnered with Justice in Aging in advocating on behalf of services for seniors. They are also working for Disability Rights California.
For more on Choice in Aging, visit their website: www.choiceinaging.org
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